Factors Affecting Postoperative Pulmonary Function After Segmentectomy For Lung Cancer
Samina Park, Jaewon Song, Kwon Joong Na, Hyun Joo Lee, In Kyu Park, Chang Hyun Kang, Young Tae Kim.
Seoul National University Hospital, Seoul, Korea, Republic of.
BACKGROUND Segmentectomy has been implemented to provide pulmonary function preservation for early lung cancer or compromised patients with intolerance to lobectomy. We assessed postoperative pulmonary function changes according to various anatomical considerations and identified associated factors to preserve pulmonary function.
METHODS We identified patients who had conducted pre- and post-operative pulmonary function test before and after undergoing segmentectomy for lung cancer from Jan 2010 to Apr 2017. Excluding cases with multi-lobar resection of ipsilateral/contralateral lobes, segmentectomy for benign etiology, and patients who underwent completion lobectomy, a total of 203 patients were included in this study. The intersegmental plane was cut by a stapler and postoperative pulmonary function was assessed at six months after segmentectomy in all patients.
RESULTS There was no postoperative mortalities and morbidity rate was 12.3%. Upper division segmentectomy was most frequently performed (n=67, 33%). Postoperative FEV1% significantly decreased compared to baseline FEV1% after segmentectomy (figure). In the univariate linear regression analysis, compromised segmentectomy (p=0.003), age (p=0.005), baseline FEV1% (p<0.001), baseline DLCO% (p=0.031), lower lobes (p=0.031), and the number of resected segments(p<0.001) were significantly associated with the changes in FEV1%. The final multiple linear regression model revealed that age (p=0.046), the number of resected segment (p<0.001), baseline FEV1% (p=0.002), preoperative FEV1/FVC%<70% (p=0.017), and postoperative complication (p=0.014) were significantly associated with changes in FEV1%.
CONCLUSIONS Segmentectomy showed potential benefits for compromised patients with old age, low FEV1/FVC%, and low preoperative FEV1% value. Moreover, the resection of one or two segments showed to significantly better preserve pulmonary function than the resection of three or four segments.
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